(INF-P1) Treatment of ureaplasma meningitis in an extreme preterm infant
Ureaplasma species are commonly found in the vaginal flora and have been associated with adverse pregnancy outcomes such as miscarriage, prematurity, stillbirth. Intrauterine and/or postnatal infection with Ureaplasma species has been shown to be a risk factor for complications in extremely preterm infants. There is a link between respiratory colonization and neonatal lung disease (bronchopulmonary dysplasia). Although there are several case reports, case series and small prospective studies on neonatal ureaplasma meningitis the association and/or causality between Ureaplasma and infection of the central nervous system remains largely unclear.
Case Presentation Summary
An extremely premature infant (born gestational week 23), 550 g, developed bilateral grade 3 intraventricular bleeding and hydrocephalus on day 10 and received a Rickham reservoir to reduce ventricular dilatation. Bacterial meningitis was suspected when cerebrospinal fluid (CSF) showed unexpected pleiocytosis and high protein levels. Treatment was initiated with meropenem and vancomycin. Biochemical analyzes from CSF continued to indicate meningitis but repeated cultures from CSF were negative while 16SrRNA PCR consistently showed Ureaplasma parvum even after the addition of ciprofloxacin. After a period of 2 months when neurological deteriorations were encountered the Rickham reservoir was exchanged during high dose treatment with ciprofloxacin and the 16SrRNA PCR eventually became negative.
This case illustrates the issues in diagnosing Ureaplasma meningitis as well as antibiotic treatment without cultures and resistance testing. Removal of foreign material (in our case Rickham reservoir) may be required in meningitis caused by Ureaplasma species since the bacteria are biofilm active.